Policy makers can try to reshape the system, but there are dangers in trying to overspecify, not least the unintended consequences of central direction which may not make sense for local context. Also, doing this precludes getting the advantages of innovation and creativity that can be unleashed where primary care is (re)designed and run locally on the basis of independent businesses and vibrant networks of enthusiastic practitioners from a range of health professions.
The approach we propose is:
- Identify the design principles that patients or the public would want to see embedded in a new primary care model.
- Develop enough specificity to allow these to be applied in practice, but leaving a great deal of room for local creativity.
- Create contractual mechanisms, approaches to measurement, and rules of behavior that foster the evolution of new models while managing some of the risks associated with this.
- Develop new models and approaches to provision that create some tension in the system and that will promote innovation and change (or at least fill in some of the gaps in those areas where new models may not develop so quickly).
Improving the design of primary care
If we are trying to improve the design of primary care it is useful to ask the question – what can we infer about the design principles of the current primary care and wider system and how might changing these produce a different result? In other words, how does primary care work (or not) for patients, the public and professionals, and how might we redesign services to address this?
Rather than specify a particular primary care model or organization, it makes sense to determine the key attributes required.
The following present a suggested set of design principles for primary care. They will need to be adapted to local contexts and take into account the wide variety of different approaches found across Europe. At their heart, however, there is a key idea that patients have a professional who can work with them over time to manage and improve their health and that there is more standardization in the approach taken.
New design principles: